JFS KidSuccess: Addressing Trauma in Children and Adolescents
Childhood trauma is a social problem that is present in every community. It is a problem surrounded by so much stigma that it is often left undiscussed. Many therapists on the KidSuccess team have worked with children who have experienced trauma. Two-thirds of American children and adolescents report at least one trauma. With the devastating outcomes that stem from childhood trauma, a successful treatment model needed to be developed, studied, and implemented.
Trauma-focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based approach designed to help children, adolescents, and families after experiences of trauma or maltreatment. TF-CBT is broken up into three phases. Phase one includes stabilization skills including components such education about trauma, relaxation techniques, and affective skills. Phase two is known for its use of trauma narration and processing. Components of phase three include in vivo mastery and conjoint child-parent sessions. Recent studies show that TF-CBT is the most effective approach to decreasing PTSD symptoms when compared to other methods of psychotherapy.
Techniques used to implement TF-CBT include in vivo mastery, narration formation, and relaxation techniques. In vivo mastery involves direct exposure to a feared situation. The first step is to rank feared situations on a ladder so that the client can slowly work up to the most feared situation. While this technique has proven to be helpful, it is not appropriate for all clients. In vivo mastery should only be used when the situations that the child is avoiding are necessary to resume normal functional behavior.
Along with in vivo mastery, narration formation is a technique that allows clients to experience success in TF-CBT. Narration formation, like much of the work surrounding patients with difficult trauma, is not an easy process for the client or the therapist. Narration formation involves the client describing increasingly detailed reports of the trauma they have experienced. While this process can be thought of as “speaking the unspeakable,” the aim of this exercise is to enable the child to learn a mastery rather than avoiding these painful memories.
Lastly, relaxation techniques have been proven to be an important technique in TF-CBT. Progressive muscle relaxation and visualization can help traumatized children cope. These relaxation skills and techniques can change according to the client’s developmental stage and interest. These skills are taught and practiced during therapy sessions, and the client should utilize them outside of therapy. If relaxation is utilized properly, the client will begin to develop the ability to manage symptoms of stress. Once several preferred techniques are identified, the therapist should model these relaxation techniques to the parents or caregivers and discuss how to utilize the relaxation techniques when the client appears distressed.
By Louis Curto, MSW Intern, KidSuccess Therapist Intern
